- Oct 31, 2021
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- Oct 3, 2021
My patient returned a folded paper to me. This was a safety plan, a contingency to help when thoughts of self-harm appeared. One month ago, this individual thought about ending her life, and even had plans how to make that happen. That first visit made my own blood pressure rise. On top of severe depression, she suffered from anxiety, insomnia, and some other symptoms which concerned me for manic tendencies, the type of things I would prefer to refer to someone more specialized, but I doubted this patient was willing to go to the one hospital in the capital city with a psychiatrist and an inpatient mental health ward. Our city doesn’t have many resources to support emergency mental health situations, so we creatively brainstormed how she could stay safe until the next visit. A month ago, I prescribed an easy-to-get medication which could help with sleep, and gave the patient my personal number, a boundary I don’t often cross, but felt appropriate in case of emergencies. That evening, I sent off an SOS email to my best buddy from medical school, a psychiatrist who knows me and my context and helps me with the tough stuff.
The following day, I spent the morning sifting through local resources, referral options, guidelines for diagnosing bipolar disorder, and checking with area pharmacies to inventory every available medication and balance side effects. My friend stayed up until 3 am California time, not resting until sure that we had a good plan moving forward. I connected with the patient via email to offer encouragement, and learned she was already improving her sleep and exercise, and had stopped drinking alcohol. A follow-up visit two weeks ago showed the patient much better even on the simple medication, and we agreed to be cautiously optimistic. Today, at our third visit one month in, she returns the action plan to me, indicating that it probably won’t be needed in the future. This individual is using healthy reframing to turn destructive thoughts into productive thought, and investing deeply in positive relationships. “At one point I felt so trapped, [I had] no hope” the patient confides as we finish our visit, “I don’t feel trapped anymore.”
I’ve walked alongside many patients during dark times, and I know that rapid recoveries are so rare that I openly celebrate them as the miracles they are. Today, my in-office spiritual support is a prayer of thanksgiving, giving God glory for the healing. My patient believes these prayers are part of what brought healing. Even amidst struggles to reconcile a strict Muslim upbringing with current lifestyle and values, this individual sees value in prayer and meditation. I hope that I can continue to walk beside her and witness the processes of discovering purpose and joy.
My patient and I agree to remain cautiously optimistic, because nobody can predict how long healthy times will last or when darkness will return. My next patient reminds me of this. Last night I received an email from him asking “Why don’t I feel better? When will I ever feel like the sadness is gone?” And today, indicators show his mood is as low as the day we met two months ago. I don’t have specific answers, but since this patient is a Christian, I cite examples from heroes of faith, reminding of countless men and women who went through much darkness themselves before returning to a taste of God’s glory. Ninety minutes later, it seems there is at least a way forward. Our prayer is for fast, miraculous healing and patience to stay strong until then.
It is a blessing for me to help provide care to people in some of their darkest hours. Sometimes, it stretches me professionally, and I need all the support available. Other times, the very same day that I encourage a patient saying that they can’t control life’s outcomes, I feel personally drained and discouraged not only because I can’t control the healing process in others, but I can’t even control my feelings of depletion at the end of a long day. I praise God that I am in a place with deep resiliency, where I can serve others well because I am renewed in my own heart, body, and soul. But I continue to pray for wisdom so I can be faithful with the opportunities that come across my path and into my office.
- Oct 3, 2021
Pruning is my least favorite part of gardening. It’s probably my least favorite part of life, too. I love watching the growth of new branches and buds; one of my newest pastimes is guiding a vine as it climbs along our chain fence and supporting our bougainvillea bushes as they climb up to meet the vines on our grape arbor. But pruning is hard. We’ve planted some bonsai trees a few months ago, and it has been excruciating watching all the leaves fall from my plants during the cold months. With the warmer weather, my plants are coming to life with miniature leaves, but I know they will overextend themselves if I don’t carefully prune and re-direct each branch.
My friend told me that Bonsai trees should be a relaxing hobby for a busy doctor. I’m not so sure, with my decidedly un-green thumb and my disinclination for failure, but the little miniature trees are helping me reaffirm the importance of seasons for growth and regeneration, direction and intentionality, and the necessity of pruning. For much of my life, I have tried to find balance by pursuing achievements in a variety of dimensions. Happy to please others and excruciatingly unable to say no, the only types of pruning that usually happen in my life are the things that fall away because I am focused on those which demand my attention. But this is a new beginning in my life, in a sense. Never before have I had so much flexibility in my daily schedule and my potential impact areas.
I know I want to deeply invest in community development and public health. We have had some encouragement from villages where pastors are working alongside local leaders to bring hope and healing, and some discouragement when things are taking a long time to start or going in a self-focused direction. We want to help provide more mentorship to each area which has already received training, but we also recognize that there are at least five more areas, 130 or more churches, which are still desperate for their first trainings. We are discussing ways to root deeper and branch out with our existing training partners, and we are looking into ways to partner with new organizations and introduce more programs. These are exciting opportunities, but they are the type of developments which will take years to decades to show fruit.
In the meantime, it’s hard not to jump at every opportunity available to me on the easier days. I want to help in the clinic in the refugee camp, to spend more hours seeing patients and helping with the staff shortage in ABC clinic. I want to mentor younger doctors and develop myself professionally and develop training programs for others. Every day there seem to be more opportunities I could dive into, and each of them has potential for meaning and impact. I have been very hesitant about taking on any official commitments, I do limit my work to 8 hours a day, and I do try to make sure that I sleep well and exercise. I think the busy days are my favorites, the ones when I can jump from project to project and feel like I am making a difference. The slower days are harder – days of meeting and troubleshooting, planning, and most painful of all, saying no or sitting back and letting others go forward on a project without me.
Pruning will probably always be the hardest part for me. I hate the feeling of letting go of a branch, of choosing between good opportunities. But as I watch my little bonsai trees grow, it affirms just how dependent an excellent outcome is upon selectivity and intentionality. God give me the strength to say no to what is good but not best and the wisdom to know between these unprecedented opportunities.
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